Citation Nr: 18152869 Decision Date: 11/27/18 Archive Date: 11/26/18 DOCKET NO. 16-47 366 DATE: November 27, 2018 ORDER Entitlement to service connection for degenerative disc disease, L5-S1, (claimed as degenerative arthritis of the spine) is denied. FINDING OF FACT The Veteran’s degenerative arthritis of the spine is not etiologically related to any disease, injury, or event in service; degenerative arthritis of the spine was manifested to a compensable degree within one year of discharge from service and symptoms of arthritis were not continuous since service. CONCLUSION OF LAW The criteria for entitlement to service connection for degenerative arthritis of the spine have not been met. 38 U.S.C. §§ 1101,1110, 1131, 1154 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the U.S. Army from September 1985 to May 1988. This case comes before the Board of Veterans’ Appeals (Board) from an August 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, MN, denying the Veteran’s claim for service connection for degenerative disc disease, L5-S1. The Veteran filed a Notice of Disagreement (NOD) in April 2016. The RO issued a Statement of the Case in September 2016 again denying the claim, and the Veteran appealed and timely perfected his appeal to the Board in VA Form 9 in September 2016. 1. Entitlement to service connection for degenerative arthritis of the spine The Veteran contends that he is entitled to service connection for degenerative disc disease L5-S1, which was caused by his military service. Generally, service connection may be granted for disability or injury incurred in, or aggravated by, active military service. See 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (2017). In order to establish service connection for a claimed disorder, there must be (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). For veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including degenerative joint disease, are presumed to have been incurred in service if they manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1112, 1137 (2012); 38 C.F.R. §§ 3.307, 3.309 (2017); Walker v Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In the instant case, there is no presumed service connection because the Veteran was not diagnosed with arthritis of the spine within one year of separation of service, indeed, was not diagnosed until many years later. The Board has reviewed all the evidence in the record. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate each claim and what the evidence in the claims file shows, or fails to show, with respect to each claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (2012); 38 C.F.R. § 3.102 (2017); see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). As an initial matter, the record shows that the Veteran has been diagnosed with degenerative arthritis of the spine. Thus, the Board finds the current disability element is established. Shedden v. Principi, 381 F.3d 1163, 1167 (2004). Additionally, service treatment records show that the Veteran was treated for a back injury in service. As such, there is evidence of an event, injury, or disease in service. Accordingly, the issue turns upon whether there is evidence of a nexus between the in-service injuries and the present disability. Id. Turning to the evidence of record, a November 1987 service treatment record shows that the Veteran reported having injured the left side of his back after he fell of a personnel carrier tank, the medical assessment denotes a bruised posterior deltoid. No muscle spasms or change in duty were noted. A December 1987 entry noted that the Veteran was seen for a clearing physical and the examiner indicated that the Veteran was examination and was free of any physical disabilities. In January 1988 discharge examination, the Veteran reported that his health was good and reported no back issues. He specifically denied swollen or painful joints and arthritis. On the associated examination report, the Veteran’s spine and musculoskeletal structure were evaluated as clinically normal. Post service, in a December 1992 medical record shows the Veteran reported that he injured his lower back in May 1992 on the job, he also reported numbness in lower back and down to his left leg. The next complaint of back pain is recorded in the Veteran’s private medical treatment records dated November 1993, where he complained of localized left low back pain, which was deemed to be associated with low back strain. A September 2008 record evidences that the Veteran reported being involved in a motor accident which caused numbness in the low back. An August 2014 VA treatment record shows that the Veteran reported having injured his back in 1985 during a training exercise, he stated that he injured when his armored vehicle flipped. Further, he claimed that he received injections in 2005 or 2006 and received chiropractic treatment for his back condition, but did not proffer medical records because these were over a decade old and thus destroyed. The Veteran was afforded a VA examination in August 2015. He reported that he injured his back in service when he fell off the track of a personnel carrier in 1987, where he landed in his left posterior shoulder and left side. Stated he had a medical evaluation but could not remember any-follow-up. He denied any other back injury and military. The Veteran reported no back trauma since service, but stated that in 2009-2010 he was involved in a motor vehicle accident that may have aggravated his back, but noted that he did not receive a medical evaluation. He averred that he sought chiropractic treatment for his back about two years after service separation, but was unable to get records because the care provider was no longer in service. The examiner diagnosed the Veteran with degenerative disc disease, L5-S1, and opined that the Veteran’s degenerative disc disease is less likely than not related to the injury in 1987 noted in the service treatment records. In his August 2015 Notice of Disagreement (NOD), the Veteran asserted that his current disability is a result of the injury he sustained during a vehicle accident while stationed in Germany. He claimed that his private care medical records demonstrate he has received continuous care for his back injury. The Veteran was afforded Medical Opinion in August 2016. The examiner provided a negative opinion, opining that there is no temporal association between the injury in the service treatment records in 1987 and the current back issues. The examiner pointed that (1) the Veteran sustained an injury to the posterior deltoid in 1987; (2) the clearing physical in December 1987 was silent for back issues; (3) the separation exam in January 1988 was silent for back issues; and (4) the Veteran’s medical records are silent for back issues until his primary care visit in August 2014. Reasoning that the Veteran’s degenerative disc disease of the back is less likely than not related to the 1987 injury noted in the service treatment records. The August 2016 VA medical opinion report is persuasive and probative evidence against the Veteran’s claim of service connection for degenerative disc disease. The VA examiner’s conclusions are shown to have been based upon a review of the Veteran’s claims file and acknowledgement of the Veteran’s lay statements. Moreover, the opinion is supported by a sufficient explanation and reference to pertinent evidence of record. See Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) (VA examination report “must be read as a whole” to determine the examiner’s rationale). Furthermore, the conclusions are consistent with the evidence of record. See Nieves-Rodriguez, 22 Vet. App. at 304 (2008) (holding, in the context of weighing one medical opinion with another, that “[i]t is the factually accurate, fully articulated, sound reasoning for the conclusion... that contributes probative value to a medical opinion”). Specifically, the examiner concluded that the Veteran’s current degenerative disc disease was not related to the in-service back injury because the Veteran did not endorse any ongoing back symptoms during his discharge examinations in December 1987 and January 1988 and because the Veteran reported no further back complaints until May 1992 after a fall at work. The Board acknowledges the Veteran’s assertions that his current low back condition is related to his in-service back injury. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, the etiology of a back condition falls outside the realm of common knowledge of a lay person. In this regard, while the Veteran can competently report his symptoms, any opinion regarding whether his diagnosed degenerative disc disease is related to his military service requires medical expertise that the Veteran has not demonstrated. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376 (2007). As such, the Board assigns no probative weight to the Veteran’s assertions that his current low back condition is related to his in-service back injury. On the question of continuity of symptomatology, the record lacks evidence in favor of finding continuity. First, the Veteran’s clearing physical in December 1987 was silent for back issues. Second, during his Army separation exam, in January 1988, the Veteran did not endorse any ongoing back symptoms. Third, the record demonstrates the first post-service complaint for back issues arose in May 1992 after the Veteran sustained a fall at work. Fourth, the Veteran’s medical records are silent for back issues until his primary care visit in August 2014. 38 C.F.R. § 3.309(b) (2017). Likewise, there is no evidence to support a finding of chronicity because the claimed lumbar strain condition did not manifest to a compensable degree within one year from the date of separation of service. 38 C.F.R. § 3.309(a) (2017). (Continued on the next page)   Taking into account all of the relevant evidence of record, the preponderance of the evidence is against a finding of an etiological relationship between the Veteran’s current degenerative disc disease and his military service. Accordingly, the Board finds that the claim of entitlement to service connection for a low back condition must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Steele, Associate Counsel